Timely dying in dementia: Use patients' judgments and broaden the concept of suffering
Abstract Patients living with advanced dementia (PLADs) face several challenges to attain the goal of avoiding prolonged dying with severe suffering. One is how to determine when PLADs’ current suffering becomes severe enough to cease all life‐sustaining treatments, including withdrawing assistance...
| Main Authors: | , , |
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| Format: | Article |
| Language: | English |
| Published: |
Wiley
2024-01-01
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| Series: | Alzheimer’s & Dementia: Diagnosis, Assessment & Disease Monitoring |
| Subjects: | |
| Online Access: | https://doi.org/10.1002/dad2.12527 |
| _version_ | 1797242539437195264 |
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| author | Stanley A. Terman Karl E. Steinberg Nathaniel Hinerman |
| author_facet | Stanley A. Terman Karl E. Steinberg Nathaniel Hinerman |
| author_sort | Stanley A. Terman |
| collection | DOAJ |
| description | Abstract Patients living with advanced dementia (PLADs) face several challenges to attain the goal of avoiding prolonged dying with severe suffering. One is how to determine when PLADs’ current suffering becomes severe enough to cease all life‐sustaining treatments, including withdrawing assistance with oral feeding and hydrating, a controversial order. This article broadens the concept of suffering by including suffering that cannot be observed contemporaneously and the suffering of loved ones. Four paradigm shifts operationalize these concepts. During advance care planning, patients can judge which future clinical conditions would cause severe suffering. To decide when to allow patients to die, treating physicians/providers only need to assess if patients have reached patients' previously judged, qualifying conditions. Questions: Will this protocol prevent PLADs’ prolonged dying with suffering? Deter early‐stage dementia patients from committing preemptive suicide? Sway decision‐making surrogates from withholding life‐sustaining treatments from patients with middle‐stage dementia? Provoke providers’ resistance to relinquish their traditional, unilateral authority to determine patients’ suffering? |
| first_indexed | 2024-04-24T18:40:50Z |
| format | Article |
| id | doaj.art-40d66dcb6aed4c319106b3b706db274c |
| institution | Directory Open Access Journal |
| issn | 2352-8729 |
| language | English |
| last_indexed | 2024-04-24T18:40:50Z |
| publishDate | 2024-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Alzheimer’s & Dementia: Diagnosis, Assessment & Disease Monitoring |
| spelling | doaj.art-40d66dcb6aed4c319106b3b706db274c2024-03-27T13:14:40ZengWileyAlzheimer’s & Dementia: Diagnosis, Assessment & Disease Monitoring2352-87292024-01-01161n/an/a10.1002/dad2.12527Timely dying in dementia: Use patients' judgments and broaden the concept of sufferingStanley A. Terman0Karl E. Steinberg1Nathaniel Hinerman2Caring Advocates Sausalito California USAShiley Haynes Institute for Palliative Care California State University, San Marcos San Marcos California USASchool of Undergraduate Studies Department of Psychology, Golden Gate University San Francisco California USAAbstract Patients living with advanced dementia (PLADs) face several challenges to attain the goal of avoiding prolonged dying with severe suffering. One is how to determine when PLADs’ current suffering becomes severe enough to cease all life‐sustaining treatments, including withdrawing assistance with oral feeding and hydrating, a controversial order. This article broadens the concept of suffering by including suffering that cannot be observed contemporaneously and the suffering of loved ones. Four paradigm shifts operationalize these concepts. During advance care planning, patients can judge which future clinical conditions would cause severe suffering. To decide when to allow patients to die, treating physicians/providers only need to assess if patients have reached patients' previously judged, qualifying conditions. Questions: Will this protocol prevent PLADs’ prolonged dying with suffering? Deter early‐stage dementia patients from committing preemptive suicide? Sway decision‐making surrogates from withholding life‐sustaining treatments from patients with middle‐stage dementia? Provoke providers’ resistance to relinquish their traditional, unilateral authority to determine patients’ suffering?https://doi.org/10.1002/dad2.12527advanced dementiaadvanced instructional health care directivesceasing oral nutrition and hydrationend‐of‐life sufferingtiming of allowing patients to diewithdrawing life‐sustaining interventions |
| spellingShingle | Stanley A. Terman Karl E. Steinberg Nathaniel Hinerman Timely dying in dementia: Use patients' judgments and broaden the concept of suffering Alzheimer’s & Dementia: Diagnosis, Assessment & Disease Monitoring advanced dementia advanced instructional health care directives ceasing oral nutrition and hydration end‐of‐life suffering timing of allowing patients to die withdrawing life‐sustaining interventions |
| title | Timely dying in dementia: Use patients' judgments and broaden the concept of suffering |
| title_full | Timely dying in dementia: Use patients' judgments and broaden the concept of suffering |
| title_fullStr | Timely dying in dementia: Use patients' judgments and broaden the concept of suffering |
| title_full_unstemmed | Timely dying in dementia: Use patients' judgments and broaden the concept of suffering |
| title_short | Timely dying in dementia: Use patients' judgments and broaden the concept of suffering |
| title_sort | timely dying in dementia use patients judgments and broaden the concept of suffering |
| topic | advanced dementia advanced instructional health care directives ceasing oral nutrition and hydration end‐of‐life suffering timing of allowing patients to die withdrawing life‐sustaining interventions |
| url | https://doi.org/10.1002/dad2.12527 |
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